PATIENT DETAILS
Mrs EG
DOB
11.09.1975 (Aged 34 at first presentation)
Medical History
Fit and Well
Allergies
No known drug allergies
Smoking history
Stopped smoking approximately 2 years prior to presentation. Smoked roll
ups for 15 years.
Family history
Nil relevant
Social History
Works at a retail outlet.
REFERRAL AND PRESENTING COMPLAINT
Referred by her general dental practitioner in June 2009 regarding pus exudate from the UL1. When
seen on the clinic in March 2010, she had no presenting complaints or concerns.
HISTORY OF PREVIOUS TREATMENT
The patient had a presenting complaint of pus exudate from the UL1 when she had initially been
referred to the periodontology clinic in June 2009. She was seen on the undergraduate clinic where
she had root surface debridement under local anaesthetic for all quadrants. She was then referred
onto the postgraduate clinic for further management of her periodontal disease.
DENTAL HISTORY
She was an irregular attender until 2009. All four third molar teeth were extracted under general
anaesthetic in January 2009 and she was referred to the periodontal clinic by her general dental
practitioner after that.
ORAL HYGIENE
The patient used
-
An oscillating rotating electric toothbrush twice daily
Green TePeTM (0.8mm) interdental brushes daily
ON EXAMINATION
EXTRA ORAL
No abnormalities detected
High Lip Line when smiling, showing gingival margins
Case Report Mrs EG
INTRA ORAL
No soft tissue abnormalities detected
DENTITION
Minimally restored
No obvious tooth surface loss noted
Spaces between UL1,2 and UR2,3
Upper lateral incisors rotated
OCCLUSION
Incisor Relationship
Molar relationship
Excursions
Class I
Class III on the right and left sides
UR1 and the LR2, LR1 were in contact during protrusive excursion.
Canine guided in the right lateral excursion
Group function in the left lateral excursion with the UL45 in contact
ORAL HYGIENE
Scattered deposits of interproximal plaque present in sites localised to the lower molar teeth
Rough deposits were detected on root surfaces.
Plaque score of 4%
PERIODONTAL TISSUES
Gingivae - marginal tissue inflammation
40% of sites with bleeding on probing
Thin gingival tissue biotype
Deep probing depth range: 5-9mm affecting anterior and posterior teeth
Mobility of the upper left and right last molar teeth and the upper left first premolar
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Case Report Mrs EG
PREOPERATIVE VIEWS (MARCH 2010)
ANTERIOR VIEW
RIGHT BUCCAL
LEFT BUCCAL
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Case Report Mrs EG
UPPER OCCLUSAL
LOWER OCCLUSAL
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Mobility
Furcation
Recession March
2010
Probing depth March
2010
buccal
lingual
right
lingual
buccal
Probing depth March
2010
Recession March
2010
Furcation
Mobility
8
•
••
• ••
•••
1 1 1
Grade 2
•
•
Grade I
••
6
•
5
4
3
• •
2
1
1
•
2
3
•
4
5
•
•
6
7
•
Grade I
•
Grade I
5 2 3 3 3 9 5 3 5 3 2 3 5 3 7 5 3 6 3 2 3 3 2 3 3 2 3 3 2 3 8 2 5 5 2 3 8 3 7 5 7 6
5 3 5 5 3 9 7 3 7 3 3 3 4 3 7 5 2 5 3 2 3 2 2 2 2 2 2 2 2 3 7 7 7 7 5 5 8 3 6 8 3 9
7
••••••••••••
7 3 8 3 3 8 3 3 5 3 3 8 3 5 7 3 2 2 2 2 2 2 2 5 2 2 2 2 2 3 7 5 5 5 2 5 7 2 3 7 3 7
9 8 7 5 3 7 5 3 6 3 2 9 5 2 7 3 2 2 2 1 2 2 7 6 5 2 3 3 2 3 8 8 5 5 3 5 7 3 5 5 3 7
••••
Grade I
8
Case Report Mrs EG
PREOPERATIVE PERIODONTAL CHART (MARCH 2010)
Denotes Bleeding on Probing. Pockets > or equal to 5mm are highlighted in red
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Case Report Mrs EG
SPECIAL INVESTIGATIONS – PERIAPICAL RADIOGRAPHS
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Case Report Mrs EG
Radiographs revealed evidence of:
1. Approximately 80-90% loss of bone height in the upper right molar region with a vertical
defect associated with the mesial aspect of the UR6
2. Approximately 50-60% loss of bone height in the upper right premolar and canine region
with vertical defects associated with the mesial aspects of the UR5 , UR4 , UR3
3. Approximately 50% loss of bone height associated with the upper left central and lateral
incisor region
4. Approximately 80-90% loss of bone height in the upper left first premolar and upper left
molars region with vertical defects associated around the mesial aspect of the UL4, UL5, UL6
5. Approximately 50% loss of bone height around the lower right canine and premolar region
with a vertical defect associated with the mesial aspect of the LR5
6. Approximately 90% loss of bone height and a vertical defects associated with the mesial root
of the LR6
7. Approximately 50% loss of bone height around the lower left premolar and molar regions
with vertical defects associated with the mesial aspects of the LL4, LL5, LL6 , LL7
8. Radiolucencies associated with the inter-radicular regions of the UL6, UR6, UR7 suggesting
furcation bone loss
9. Divergent root form of the multi-rooted UR7, UR6 and UL6 and convergent root form of the
UL7
10. No radiographically evident root surface deposits
11. No caries or periapical pathology noted
SENSIBILITY TESTING
Tooth
UL1
UL4
UR7
UL7
Cold Test
+ve
+ve
+ve
+ve
EPT
12
15
14
17
Start from discussing findings.
Discuss what is your diagnosis and prognosis and how would you manage this patient
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